OB prep u Ch. 7

The nurse is developing a presentation about urinary incontinence for a local women's group. Which of the following would the nurse be least likely to include in the discussion?

Urinary incontinence is a normal part of aging.

A 36-year-old was diagnosed with uterine fibroids (leiomyomas). The nurse teaches the client to expect which of the following clinical manifestations?

Abnormal uterine bleeding Fibroids are dependent on estrogen and grow rapidly during the childbearing years unless menopause occurs. Abnormal uterine bleeding is a clinical manifestation. Diarrhea is not a factor; constipation and abdominal pain can occur if fibroids are getting larger.

A client who reported changes in her normal voiding patterns and altered bowel habits is diagnosed with polycystic ovarian syndrome. Which instruction is most appropriate for the nurse to provide the client to help alleviate her condition?

Adhere to follow-up care The nurse should stress follow-up care to the client with polycystic ovarian syndrome so that the client does not overlook this benign disorder. Increasing intake of fiber-rich foods, increasing fluid intake, and performing Kegel exercises help to control pelvic organ prolapse, not polycystic ovarian syndrome.

Assessment of a client reveals evidence of a cystocele. The nurse interprets this as which of the following?

Bulging of the bladder into the vagina A cystocele is the bulging of the bladder into the vagina. A rectocele is a herniation of the rectum into the vagina. An enterocele is a protrusion of the intestinal wall into the vagina. A uterovaginal prolapse is the downward displacement of the cervix anywhere from low in the vagina to outside the vagina

The nurse is giving instructions on pessary usage for a client diagnosed with uterine prolapse. Which of the following instructions are important for the nurse to provide?

Call the health care provider if you experience painful urination. Clients that use a pessary device should notify the health care provider if they experience any symptoms of a urinary infection. Use of a pessary device puts clients at risk. The other instructions apply to clients with a type of prolapse and would be considered lifestyle modifications.

A woman is diagnosed with polycystic ovarian syndrome (PCOS). Which of the following treatments would the nurse not explain to the client?

Estrogen replacement therapy All listed medications are part of the treatment modality for PCOS. Estrogen replacement therapy is used in structure/prolapse disorders to improve tone and vascularity of supporting tissues.

A nurse is caring for a client for whom estrogen replacement therapy has been recommended for pelvic organ prolapse. Which nursing intervention is the most appropriate for the nurse to implement before the start of the therapy?

Evaluate the client to validate her risk for complications Before starting estrogen replacement therapy, each woman must be evaluated on the basis of a thorough medical history to validate her risk for complications such as endometrial cancer, myocardial infarction, stroke, breast cancer, pulmonary emboli, or deep vein thrombosis. The effective dose of estrogen required, the dietary modifications, and the cost of estrogen replacement therapy can be discussed at a later stage when the client understands the risks associated with estrogen replacement therapy and decides to use hormone therapy.

Myomectomy is recommended to a client for removal of uterine fibroids. The client is concerned about the surgery and wants to know if there are any associated disadvantages. Which is a disadvantage of myomectomy?

Fibroids may grow back. The disadvantage of myomectomy is that the fibroids may grow back in the future. Fertility is not jeopardized because this procedure leaves the uterine wall intact. Weakening of the uterine walls, scarring, and adhesions are caused by laser treatment, not myomectomy

The physician has prescribed estrogen replacement therapy (ERT) for a menopausal woman who has been diagnosed with pelvic organ prolapse (POP). The patient asks the nurse why she needs to be on hormones. The nurse's best response to this would be which of the following?

Hormone replacement will increase blood perfusion and the elasticity of the vaginal wall. Hormone replacement therapy may improve the tone and vascularity of the supporting tissue in perimenopausal and menopausal women by increasing blood perfusion and the elasticity of the vaginal wall.

A patient comes to the genitourinary (GU) clinic with very mild symptoms of pelvic organ prolapse (POP) that has just started in the last several days. The first treatment of choice for this patient would be which of the following?

Kegel exercises Kegel exercises strengthen the pelvic floor muscles to support the inner organs and prevent further prolapse, They might limit the progression of mild prolapse and alleviate some symptoms. They will not, however, help severe uterine prolapse. Surgery is for more severe cases. Doing nothing is not an option and the colpexin sphere would be used in a case that had more pronounced symptoms.

The nurse is educating a woman on interventions to alleviate the signs and symptoms of polycystic ovarian syndrome. Which of these instructions would be helpful for relief of symptoms?

Maintain follow-up appointments. Most cysts are benign, but it is important for the nurse to stress the need for follow-up appointments to monitor the cysts. Women with this syndrome are at risk for other reproductive cancers. Increasing dietary fiber and fluid intake is important for pelvic organ prolapse. Kegel exercises are performed to strengthen the pelvic floor wall in structural disorders.

The nurse is admitting a 42-year-old patient to the women's medical floor. During the history, the chief complaint from the client is "I feel like there is a lump in my vagina, and it feels like it is sometimes dragging." Which of the following disorders does the nurse suspect?

Pelvic organ prolapse In pelvic organ prolapse, the pelvic floor muscles are weak, and this results in a feeling of "dragging," or that some sort of "lump" is present in the vagina. Symptoms of pelvic organ prolapse do not include urinary incontinence. Endocervical polyps manifest with abnormal vaginal bleeding. With uterine fibroids, the uterus is large and has an odd shape.

A 40-year-old client arrives at the community health center experiencing a strange dragging feeling in the vagina. She stated that "at times it feels as if there is a lump" there as well. Which condition may be an indication of these symptoms?

Pelvic organ prolapse Weakening of the pelvic-floor muscles causes a feeling of dragging and a "lump" in the vagina; these are symptoms of pelvic organ prolapse. These symptoms do not indicate urinary incontinence, endocervical polyps, or uterine fibroids. Urinary incontinence is the involuntary loss of urine. The symptoms of endocervical polyps are abnormal vaginal bleeding or discharge. In cases of uterine fibroids, the uterus is enlarged and irregularly shaped.

Kegel exercises are recommended for a client with pelvic organ prolapse. Which should the nurse inform the client about the exercises?

They alleviate mild prolapse symptoms. Kegel exercises might limit the progression of mild prolapse and alleviate mild prolapse symptoms, including low back pain and pelvic pressure. Intake of food is not required before performing Kegel exercises. Surgical interventions do not interfere with Kegel exercises. Kegel exercises do not cause an increase in blood pressure

A nurse is caring for a 45-year-old client using a pessary to help decrease leakage of urine and support a prolapsed vagina. Which recommendation is most commonly provided to a client regarding pessary care?

Remove the pessary twice weekly, and clean it with soap and water The most common recommendation for pessary care is removing the pessary twice weekly and cleaning it with soap and water. In addition, douching with diluted vinegar or hydrogen peroxide helps to reduce urinary tract infections and odor, which are side effects of using a pessary. Estrogen cream is applied to make the vaginal mucosa more resistant to erosion and strengthen the vaginal walls. Removing the pessary before sleeping or intercourse is not part of the instructions for pessary care.

A nurse is caring for a 32-year-old client for whom pessary usage is recommended for uterine prolapse. Which instructions should the nurse include in the teaching plan for the client concerning the pessary?

Report any discomfort with urination and defecation The nurse should instruct the client using a pessary to report any discomfort or difficulty with urination or defecation. Avoiding high-impact aerobics, jogging, jumping, and lifting heavy objects, as well as wearing a girdle or abdominal support, are recommended for a client with prolapse as part of lifestyle modifications and may not be necessary for a client using a pessary

A client with abnormal uterine bleeding is diagnosed with small ovarian cysts. The nurse has to educate the client on the importance of routine check-ups. Which assessment is most appropriate for this client's condition?

Schedule ultrasound every 3 to 6 months The nurse should monitor the client with ultrasound scans every 3 to 6 months. Monitoring gonadotropin level and blood sugar level and scheduling periodic Pap smears are not important assessments for the client with small ovarian cysts.

The nurse is reviewing with a new client the diagnosis of polycystic ovarian syndrome (PCOS). Which of the following long-term health problems would the nurse review as a risk with this syndrome?

Type 2 diabetes With PCOS, the client is at risk for long-term health issues such as reproductive cancers, cardiovascular disease, hypertension, type 2 diabetes, and dyslipidemia. Migraines can be caused by many unknown factors and appear in numerous disorders. Celiac disease is not associated with PCOS. Cellulitis is an acute infection, not a long-term health issue.

The mother of four small children comes to the clinic with the complaint of a bulge between her vagina and her rectum. It is painless and has not gotten any larger since the woman noticed it two weeks ago. After the doctor examines the woman, he says he is going to refer her to a surgeon. This frightens her so after the doctor leaves the room the woman asks the nurse to explain what she has. What would the nurse tell her?

She has an enterocele because her small intestine and peritoneum are jutting downward between the uterus and the rectum. The names of pelvic support disorders correspond to the affected organs: Cystocele occurs when the bladder bulges into the front wall of the vagina. Rectocele occurs when the rectum protrudes into the back wall of the vagina.Enterocele occurs when the small intestine and peritoneum jut downward between the uterus and rectum.Uterine prolapse occurs when the uterus drops down into the vagina.

A client with large uterine fibroids is scheduled to undergo a hysterectomy. Which intervention should the nurse perform as a part of the preoperative care for the client?

Teach turning, deep breathing, and coughing The nurse should teach the client turning, deep breathing, and coughing prior to the surgery to prevent atelectasis and respiratory complications such as pneumonia. Reducing activity level and the need for pelvic rest are instructions related to discharge planning after the client has undergone a hysterectomy. A high fat diet need not be avoided before undergoing hysterectomy; avoiding a high-fat diet is required for clients with pelvic organ prolapse to reduce constipation.

Structural disorders that cause prolapse of reproductive organs in women can be aided by the practice of Kegel exercises. When the nurse is explaining Kegel exercises to a client, which of the following is most important to include?

These exercises will relieve mild prolapse symptoms. Kegel exercises can alleviate mild prolapse symptoms and may even aid in stopping the progression of prolapse. Symptoms that may be decreased include pelvic pressure and low back pain. These exercises may be done after surgery; they do not increase blood pressure and are not affected by food.

The nursing instructor is teaching a student about urinary incontinence and realizes that the student needs further instruction when she makes the following statement?

Urinary incontinence is an inevitable problem of aging. There is a widespread belief that urinary incontinence is an inevitable problem of getting older and that little or nothing can be done to relieve symptoms or reverse it. This is not true. For many women with urge incontinence simple reassurance and lifestyle changes might help. If they do not, numerous effective treatments are available

A nurse is caring for a client who has been prescribed gonadotropin-releasing hormone (GnRH) medication for uterine fibroids. For which side effect of GnRH medications should the nurse monitor the client?

Vaginal dryness Vaginal dryness is one of the side effects of GnRH medications. The other side effects of GnRH medications are hot flashes, headaches, mood changes, musculoskeletal malaise, bone loss, and depression. Increased vaginal discharge, urinary tract infections, and vaginitis are side effects of a pessary, not GnRH medications

A nurse is educating a group of students in the community clinic about pelvic organ prolapse. Which of the following can be a cause of this disorder?

Weakening of pelvic support related to childbirth trauma Pelvic organ prolapse can be caused by downward gravity from being an erect human, atrophy of muscles with aging and decreasing hormones, obesity, lifting heavy objects, reproductive surgery, and weak pelvic support due to childbirth trauma. The other choices do not cause pelvic organ prolapse

The nurse would expect which of the following patients to be at a high risk for developing a pelvic support disorder?

a 60 year-old mother of 4 Women may experience pelvic support disorders related to pelvic relaxation or urinary continence. These disorders usually develop after years of wear and tear on the muscles and tissues that support the pelvic floor, such as what occurs with childbearing, chronic coughing, straining, surgery, or simply aging.

The nursing instructor is teaching about Bartholin cysts and informs the students that Bartholin cysts are the most common cystic growth in the vulva. She describes this type of cyst as being which of the following?

a swollen, fluid-filled, sac-like structure A Bartholin cyst is a swollen, fluid-filled, sac-like structure that results when one of the ducts of the Bartholin's gland becomes blocked. A uterine fibroid is a benign proliferation composed of smooth muscle and fibrous connective tissue in the uterus. A fistual is a abnormal opening between a genital tract organ and another organ. A polyp is a small benign growth.

Which finding would the nurse most likely expect in a woman with endometrial polyps?

metrorrhagia The most frequent clinical manifestation of women with endometrial polyps is metrorrhagia. Abnormal vaginal bleeding or discharge also may occur, but metrorrhagia is more common. Endocervical polyps are cherry red; cervical polyps are grayish-white

The nurse is teaching the pre-menopausal patient about dietary and lifestyle modifications that can reduce the risk factors for developing pelvic organ prolapse (POP). This type of prevention would be an example of which of the following?

primary Informing the patient about factors in her lifestyle that might be modified to reduce her risk of developing POP would be an exmaple of primary prevention.

When assessing a client, a nurse determines that the client has a rectocele based on which finding?

sagging of the rectum, which pushes against or into the posterior vaginal wall A rectocele occurs when the rectum sags and pushes into or against the posterior vaginal wall. A cystocele occurs when the posterior bladder wall protrudes downward through the anterior vaginal wall. An enterocele occurs when the small intestine bulges through the posterior vaginal wall. Uterine prolapse occurs when the uterus descends through the pelvic floor and into the vaginal canal.

The nurse is teaching the patient who has been diagnosed with POP about factors in her lifestyle that can be modified to improve her quality of life during and after receiving her treatment. This type of prevention is an example of which of the following?

secondary As this patient has already been diagnosed with POP, informing her about factors in her lifestyle that might be modified to improve her quality of life after receiving treatment would be secondary prevention.

A patient comes to the Genitourinary (GU) clinic with complaints of accidental leakage of urine. She says it happens whenever she coughs, laughs, or sneezes. It also happens sometimes when she exercises. What should the nurse expect?

stress incontinence Accidental leakage of urine that occurs with increased pressure on the bladder from coughing, sneezing, laughing, or physical exertion is labeled stress incontinence. Urge incontinence is characterized by precipitous loss of urine preceded by a strong urge to void with increased bladder pressure and detrusor contraction. Mixed incontinence is a combination of the two.

A patient is seen in the gynecology (GYN) clinic with symptoms of a uterine prolapse. When being informed about her treatment options, she asks the nurse which is the treatment of choice. The nurse's repsonse should be which of the following?

surgery A vaginal hysterectomy is the treatment of choice for a uterine prolapse because it removes the prolapsed organ that is bringing down the bladder and rectum with it. It can be combined with an anterior and posterior repair if a cystocele or rectocele is present.

A client has undergone an abdominal hysterectomy to remove uterine fibroids. Which interventions should a nurse perform as a part of the postoperative care for the client? Select all that apply.

• Administer analgesics promptly and use a patient-controlled analgesia (PCA) pump • Administer antiemetics to control nausea and vomiting • Frequent ambulation

A nurse is assessing a 45-year-old client for uterine fibroids. Which are the predisposing factors for uterine fibroids? Select all that apply.

• Age • Nulliparity • Obesity

A nurse is caring for a female client with urinary incontinence. Which instructions should the nurse include in the client's teaching plan to reduce the incidence or severity of incontinence? Select all that apply.

• Continue pelvic floor exercises • Increase fiber in the diet • Control blood glucose levels

A nurse is caring for a woman who has just been diagnosed with uterine prolapse. Which of the following symptoms may interfere with her daily activities? Select all that apply.

• Low back pain • Pelvic pressure • Urinary frequency

A 58-year-old woman is diagnosed with uterine prolapse. Which of the following would be nonsurgical treatments available for this disorder? Select all that apply.

• Pessaries • Estrogen replacement therapy Nonsurgical interventions for a prolapse disorder include Kegel exercises, estrogen replacement therapy, diet and lifestyle changes, and pessaries. Jogging can cause pressure on the prolapse and can progress the disorder. The diet should include increased fluid and fiber to prevent constipation, which can increase intra-abdominal pressure.

After teaching a woman how to perform Kegel exercises, the woman states the steps below. Which step would the nurse determine as reflecting a correct component of Kegel exercises?

• Squeeze the rectal muscles as if trying to prevent the passage of flatus. • Stop and start urinary flow to identify pubococcygeus muscle. • Tighten the pubococcygeus muscle for a count of three, then relax. • Contract and relax the pubococcygeus muscle rapidly 10 times.

A nurse working in the OB clinic is talking to a patient who asks the nurse why her physician has not ordered estrogen replacement therapy (ERT) to treat her pelvic organ prolapse (POP). The nurse informs the patient that ERT is not for everyone and should not be given to patients who are at risk for developing which of the following? (Check all that apply.)

• endometrial cancer • myocardial infarction (MI) • stroke • breast cancer • deep vein thrombosis (DVT) • pulmonary emboli (PE)

The nursing instructor is teaching about urinary incontinence and informs the students that dysfunction of either the bladder, the urethra, or the levator muscle can cause incontiennce. She also lists which of the following to be contributing factors for incontinence? (Check all that apply.)

• fluids such as alcohol, caffeinated and carbonated drinks • constipation • habitual "preventive" emptying • advancing age • pregnancy and childbirth • obesity

When describing polycystic ovarian syndrome to a client, which areas would the nurse need to address? Select all that apply.

• hyperinsulinemia • elevated androgen levels • anovulation

A patient is seen in the clinic with symptoms of "dragging" and feeling like something is "coming down." During her assessment, the nurse should look at risk factors for a prolapse, which include which of the following? (Check all that apply.)

• vaginal childbirth • advanced age • increased body mass index